IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on Medicare Part B (learn more about "how annuities can help fund your medical tourism expenses") and Part D premiums for higher-income beneficiaries. It's based on your MAGI from two years prior — so your 2026 premiums reflect your 2024 tax return. Cross a threshold by even one dollar and the full surcharge kicks in. Here are seven strategies to reduce or avoid it.

How IRMAA works

Medicare uses your MAGI (adjusted gross income plus tax-exempt interest) from two years ago to assign you to an income bracket. Standard Part B premium applies below the first threshold; above it, you pay progressively higher surcharges across several tiers. At the top brackets, IRMAA can add roughly $400–$630+ per month in combined Part B and Part D surcharges versus the standard premium. Because it's a cliff, not a phase-in, staying just under a threshold matters enormously.

1. Time Roth conversions carefully

Roth conversions add to MAGI in the year you convert. Do them strategically — in lower-income years (e.g., between retirement and age 73) and in amounts that fill up a tax bracket without pushing you over the next IRMAA threshold. Converting before you enroll in Medicare avoids the two-year lookback hitting your premiums.

2. Use Qualified Charitable Distributions (QCDs)

If you're 70½ or older, a QCD lets you donate up to $108,000 (2025 limit, indexed) directly from your IRA to charity. The amount counts toward your required minimum distribution (RMD) but is excluded from MAGI — unlike a normal RMD, which raises it. This is one of the cleanest ways to satisfy an RMD without triggering IRMAA.

3. Harvest tax losses

Selling investments at a loss in a taxable account offsets capital gains and up to $3,000 of ordinary income per year, lowering MAGI. Pair gains with losses in the same year to keep net income under your threshold.

4. Spread out capital gains

A large one-time sale — a home, a business, appreciated stock — can spike MAGI and trigger IRMAA two years later. Where possible, spread the gain across multiple tax years, use installment sales, or time the sale for a year when other income is low.

5. Draw from tax-free and tax-deferred accounts strategically

Withdrawals from Roth IRAs and Roth 401(k)s, and the return-of-basis portion of certain accounts, don't count toward MAGI. In a year you're close to a threshold, lean on Roth and cash reserves instead of traditional IRA withdrawals to keep income down.

6. Manage HSA and other deductions

Health Savings Account contributions reduce MAGI (before you enroll in Medicare). Other above-the-line deductions and pre-tax contributions in your working or transition years lower the income that eventually determines IRMAA.

7. File an IRMAA appeal after a life-changing event

If your income dropped because of a qualifying life-changing event — retirement (work stoppage or reduction), marriage, divorce, death of a spouse, or loss of pension/income — you can file Form SSA-44 to ask Social Security to use your current, lower income instead of the two-year-old figure. This is the single most overlooked fix for recent retirees hit by IRMAA based on their final high-earning year.

A quick checklist to stay under the threshold

• Know the current year's IRMAA brackets and where your projected MAGI lands.
• Project income two years ahead — the surcharge is based on a lookback.
• Use QCDs for RMDs once you're 70½+.
• Lean on Roth and cash in years you're near a cliff.
• File Form SSA-44 promptly after retirement or another life-changing event.

Frequently asked questions

What income triggers IRMAA in 2026? IRMAA is tiered, and thresholds are adjusted annually for inflation. Because 2026 premiums use your 2024 MAGI, check the current official Medicare brackets for the exact figures that apply to you.

Does IRMAA reset every year? Yes. It's recalculated annually based on your MAGI from two years prior, so a high-income year affects only the corresponding premium year — and dropping back below the threshold removes the surcharge.

Can I appeal IRMAA? Yes — if you had a qualifying life-changing event, file Form SSA-44 with Social Security. You can also appeal if the IRS data used was incorrect or outdated.

The key is to plan two years ahead and manage MAGI deliberately. Small, well-timed moves — a QCD here, a delayed capital gain there, a timely SSA-44 — can keep you under the cliff and save thousands in Medicare premiums.

This article is educational and not tax or financial advice. IRMAA thresholds and limits change yearly; confirm current figures with Medicare and consider consulting a tax professional or financial advisor for your situation.